Journal Article

Antibiotic Combinations with Redundant Antimicrobial Spectra: Clinical Epidemiology and Pilot Intervention of Computer-Assisted Surveillance

Robert C. Glowacki, David N. Schwartz, Gail S. Itokazu, Mary F. Wisniewski, Piotr Kieszkowski and Robert A. Weinstein

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 37, issue 1, pages 59-64
Published in print July 2003 | ISSN: 1058-4838
Published online July 2003 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/376623
Antibiotic Combinations with Redundant Antimicrobial Spectra: Clinical Epidemiology and Pilot Intervention of Computer-Assisted Surveillance

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Redundant antibiotic combinations are a potentially remediable source of antibiotic overuse. At a public teaching hospital, we determined the incidence, cost, and indications for such combinations and measured the effects of a pharmacist-based intervention. Of 1189 inpatients receiving ⩾2 antibiotics, computer-assisted screening identified 192 patients (16.1%) receiving potentially redundant combinations. Chart reviews showed that 137 episodes (71%) were inappropriate. Physician overprescribing errors were found in 77 episodes (56%); most involved redundant coverage for gram-positive or anaerobic organisms. In 76 episodes (55%), lapses in the medication ordering and distribution system led to the persistence in the pharmacy records of regimens no longer active according to the patient charts. The incidence of redundant antibiotic combinations was significantly higher in the intensive care unit and surgery services, compared with medical services. Interventions to discontinue redundant agents were successful in 134 (98%) of the 137 episodes. Potential drug cost savings and reduction in redundant antibiotic combination days were $10,800 and 584 days, respectively; pharmacist time for patient review and intervention cost $2880. Use of redundant antibiotic combinations was common, and a pharmacist-based intervention was feasible, with a potential annualized cost savings of $48,000.

Journal Article.  2753 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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